Pre-treatment inflammatory parameters predict survival from endometrial cancer: A prospective database analysis

Purpose. Inflammation predisposes to tumorigenesis by damaging DNA, stimulating angiogenesis and potentiating pro-proliferative and anti-apoptotic processes. The aim of this study was to investigate whether pretreatment biomarkers of systemic inflammation are associated with survival outcomes in endometrial cancer. Patients and methods. Women with endometrial cancer were recruited to a prospective database study. Pretreatment systemic markers of inflammation, including C-reactive protein (CRP), Glasgow Prognostic Score and lymphocyte-based ratios [neutrophil-lymphocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII)], were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox regression. Results. In total, 522 women of mostly White British ethnicity, with a median age of 66 years (interquartile range (IQR), 56, 73) and BMI of 32 kg/m(2) (IQR 26, 39) were included in the analysis. Most had low-grade (67.2%), early-stage (85.4% stage I/II), endometrioid (74.5%) tumors. Women with pre-treatment CRP >= 5.5mg/L had a 68% increase in overall (adjusted HR= 1.68, 95% CI 1.00-2.81, p= 0.049) and a two-fold higher cancer-specific mortality risk than those with CRP <5.5 mg/L (adjusted HR= 2.04, 95%CI 1.03-4.02, p= 0.04). Absolute lymphocyte count, NLR, MLR and SII were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. Conclusion. If confirmed in an independent cohort, CRP may offer a simple, low-cost test to refine pretreatment risk assessment and guide personalised care in endometrial cancer. Our participants were mostly of White British ethnicity and further studies are needed to confirm the utility of CRP as a prognostic biomarker in other populations. (C) 2021 The Authors. Published by Elsevier Inc.

Automated summary

This study found that pretreatment systemic inflammation markers, such as CRP levels, are associated with survival outcomes in endometrial cancer patients. CRP may serve as a simple, low-cost predictive biomarker to guide personalized care in endometrial cancer. Further studies are needed to confirm the utility of CRP in other populations as most participants in this study were of White British ethnicity.